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General NPI Number Information
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NPI Number | 1295608420
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Entity Type | Organization
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Legal Business Name | SAN DIEGO SPORTS PHYSICAL THERAPY, PC
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Dates
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Enumeration Date | 09/24/2025
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Last Update Date | 09/24/2025
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Provider Practice Location Address
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Address Line | 8290 VICKERS ST STE C&D
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City | SAN DIEGO
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State | CA
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Zip | 92111-2116
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Country | US
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Telephone | 619-510-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 1412 PRIMROSE DR
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City | EL CAJON
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State | CA
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Zip | 92020-5644
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Country | US
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Telephone | 619-510-5000
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DEREK RUSTICH
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Credential | PT, DPT
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Telephone | 619-510-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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